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0049 BEECH LEAF ISLAND ROAD
�yB�/.�. c�� — _� I I -ALTERNATIVE WEATHERIZATION Date 1v V Town of Barnstable 200 Main St. Hyannis,MA 02601 Re: Permit ss The insulation work at has been completed In accordance with 780CMR, Agency work performed for Regards CD Timothy Cabral, J t" President CN >_ CSL-10S454 w W c W 506 ALTERNAlIvEwEATHr.RVATIONOGMAIL.COM 58 DIGKINSON STREET I FALL GIVER.MA 02721 I ( S67-4240 I) . -ALTERNATIVE WEATHERIZATION Oate K� V Town of Bamstable 200 Main St. Hyannis,MA 02601 ` Re: Permit 1t The insulation work at has been completed In accordance with 780CMR. Agency work performed inr �- AA_9-11 Regards CD 'T1 'Timothy Cabral', �� r 3 President CSL-105454 W 58 DICKINSON STREET I FALL RIVER,MA 02721 ( (508)567-A240 I ALTERNATIVEWEATHERgATION@GMAILCOM i box A Town of Barnstable Building :' �Po�s This.Card So That rt is-V�s�bleFrom�' he Street-A rpved::Plaris°Must'�,be Retained on Job and�this'Card 3Must;be Ke t � .� �.* 1A�NfTPA[i1:B, 4.�. �'3^;::,. �k .�:.. z .a_'' ;'�A� aPp� �• .saw o ^`�� ;� ��" ,.:: �.� "p` �� � '' � Where�a:Certificate.of Occu aoc is�Re ture �such�B'uild�n shall N°oi�be Oc¢u ied�untiVa Final Ins ection�has,been made 1 ei lijlt - d Permit NO. B-18-1202 Applicant Name: TIMOTHY CABRAL Approvals Date Issued: 04/26/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 10/26/2018 Foundation: Location: 49 BEECH LEAF ISLAND ROAD,CENTERVILLE Map/Lot 187 079 001 Zoning District: RD-1 Sheathing: Owner on Record: BARTLETT,JOHN W&SARAH C TRS Contractor Name ALTERNATIVE WEATHERIZATION, Framing: 1 t INC- Address: 1 MOTHBALL WAY , 2 u ._. Contractor license t1�75683 NANTUCKET, MA 02554 Chimney: Description: INSULATION/WEATHERIZATION zf Est Project Cost: $7,528.00 4 Permit Fe'e: $88.39, Insulation: Project Review Req: r z FeePaid $88.39 Final: wq gm DaIr te 4/26/2018 .. .. um ing/Gas PI b Rough Plumbing: Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced within siz months after issuance; «F Final Gas: All work authorized by this permit shall conform to the approved application and theapproved construction documentsfor which this permit has been granted. ` Y 'f All construction,alterations and changes of use of any building and steUcctures shalEbee in compliance with the local zio ng�by rs and codes. This permit shall be displayed in a location clearly visible from access stree o,road and shall be mamtamed open for pubU6-��In ion for the entire duration of the Electrical i work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Buildingand Hr.ejP' iicials are provided'on this permit. Rou h: Minimum of Five Call Inspections Required for All Construction Work:!:,-*,'* w g 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior.to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final' 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department io- "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT zR I DING DEPT. AppiicatinnNumber.. .J........�,?:..,, sr APR 2 0 2018 MASS. Permit Fee.,.,,.. � ��� other Fen.. ...... ... OWN OF BARNSTABLE TotalFee Paid.....:..........................: .........................::.,.,`....,. TOWN OF BARNSTABLE Permit Approval b BUILDING PERMIT c map......... ..Q. ........... ...... ........, APPLICATION Section 1 -.0wner's-information and Pr®jec-t'Lociition Project AddressV95 eL Z P P 1?d Village Owners Namh Owners Legal Address . 5)ee�CA Leaf :W_s7c4 Ad• Ci State Zip i ;Owners Cell ✓�0 "G� 307� E-mail �� � ; -jyl P Cdyy� Section 2 —Ilse of Structure Pse Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000,cubic feet ❑ Single/Two Family Dwelling A { Section 3—Type of Permit E New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment f Sprinkler System Addition ❑ Retaining wall ❑ Solar Renovation - /L ❑ Pool ❑ Insulation Other— Sp eci fY I,� i�,,�-(2R,fi — Section 4 - Work Description qqr � D ` - cc1 t All� P,� 016 U S s�- Last updated:3115/2018 i 3 i Application Number....... ............... ..,.......,.,.,.,,.. Section 5--Detail Cost of Proposed Construction 7�v`� Y'&V Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) l 10 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM'Checklist ❑ Design Section 6—Project Specifics ❑ Wising ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane C Yes ❑ No Section 7-Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard. Required. Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated:3/15/2018 r `." Application Number.. ....... . ...................... Section 9— Construction Supervisor Name Telephone Number Address La cS^� Cit j //JJ �? Y/' /�f1/�'' State � Zip_ 02 2a L License Number/0 ysC_ License Type Expiration Date- yal— a1WAA,6-Ve_ ,u e�J z i`v ih42 lu p Contractors Email CW771 Cell # _77, '/—j6 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,.specific inspections and documentation required y CMR and th�To ,n�f Barnstable..Attach a copy of your license. Signature. �� �^ \. � Date Section 10--Home Improvement Contractor Name/f&-r►aafM WU,A('.ram-fl-DL TAc Telephone Number "5-6?- "IA Vo , AddressA t4-4 SY City !f ,06-ve,- State Zipd,A� d Registration Number 176(0 6S Expiration Date I understand my responsibilities under the rules and regulations for Horne Improvement Contractors in accordance with 780 CMR the Massachusetts t Building C I u stand the construction inspection procedures,specific inspections and documentation require CM t To n f Barnstable. Attach a copy of your H.I.C... Signature Date /S Section 11 --Home Owners License Exemption- Home Owners Name: Telephone Number 'i _ Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed-Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNS:'UNR Signature Date V//0 Print Name I f 6t6-r\J'L Telephone Number..M' ' k� E-mail permit to; ast updated:3/15/2018 Section 12 Department Sign-Offs Health Department Zoning Board (if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ® t Conservation ❑ For commercial work,please take your plans directly to there department for or approval. Section 13— Owner's Authorization I, M/7 / t/P- , as Owner of the,subject property hereby authorize t to act on my behalf, in all matters rela 've to work thorized by this building permit application for: (Address ofjob) 1Q2r��a Signature of Owner date Print Name Last updated:3/1 5120 1 8 DocuSign Envelope ID:E5303A7F-6FB1-4A27-8808-6F7AD54C4C35 Permit'>Auth-oriZ t 4i1` rMss, save Form Site 10: 3350236 Customer john Barlett ]ohn w Bartlett I, y Q. ner of the property located at'i:4 (Owner's Name;pr►r ted) 49 Beech Leaf Island Road Centerville, MA 02632 (Property Street„Addre%) hereby atitharize the Mass Save Name Energy Services Prdgrarn assigned Participatirtg,Con tractor liste below to act-on tnybehalf and dbtain a building t permi to-perform'i'nsulation and/or weathe ilidti6h work on my progerW. DocuSigned by: y 6wneils!` IjMoture: 269D82CC6FA243A._ _ 4/3/2018 4:03 PM EDT Date: mesa.%Osa'a*** 006*see***000* i600000 FOR'OFFICf USE ONLY" We have assigned the fd1lowing Mass Save Home Energy Services'i�ar`titi at►ng C intr4�tor.tdt e, above referenceO prpject: - �1�if1V WP a ¢.t�` y . Partac pattng;Ito ntractor D te`z Name: RISE Engineering Phone: 401-784-3700 Email: Forofff.cer usa,Only Rev,102015 f The Commonwealth of Massachusetts _ Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. t Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): I.❑✓ I am a employer with 16 employees(full and/or part-time).* 7, ❑New construction am a sole proprietor or partnership and have no employees working for me in � I l i 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have(tired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. , 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:STAR INSURANCE COMPANY Policy#or Self-ins. Lic.#:0849257 00 Expiration Date:4/4/19 Job Site Address:` t&f �rS'k^d /Q City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. 1 do hereby certify under tie pains and pen es of jury that the information provided above is true and correct. Si nature: Date: Phone#:508-567-42 0 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ALTEWEA-01 SNERONHA CERTIFICATE OF LIABILITY INSURANCE DATEJMM/DDlYYYI) 03/2312018 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOt,DER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED`BY.THE POIICIEB BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. I if SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. I PRODUCER Cr Christine Costa - I Mason&Mason Insurance Agency,Inc. !PHONE FA 458 South Ave. 1(A/C,No,Ext):(781)447-6531 I VX Nfl1.(781)447.7230 Whitman,AAA 02382 M%ss:S-costa masoninsure.com � i JNSURE!qS1 AFFORDING COVERAGE NAICfi ? 3 I -- --'._-_-----_........._. __ .____..___.__. __.,:i INSURER A:Evanston Insurance Co. 3537$ INSURED INSURER B:Safety Indemnity _ 133818 ! _ _ Alternative Weatherization,Inc. iNsum c:Star Insurance Comp n 118023 2 Lark Street INsuRER D Fail River,MA 02721 s ;INSURER E: ; j INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR; ADDLISUER 1 POLICY EPF POLICY EXP I LTR I TYPE OF INSURANCE I INSO wVD POLICY NUMBER iMM1DOlYYWI I i LIMITS i A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,0U0,0001 i$ '--- CLAIMS-MADE _ `X'OCCUR )( X �3C420$$ 06/07/2fl17?061fl71201$;DAMAGE TO RENTED 100,0fi0 PREMISES lEa ocaurroxe) I S MED EXP(ArW one person) ''s s 5,000 ? ? ? --r........_...______�______..._.__.___. � NJURY 1,0fl�,000y 1 I 1 PERSONAL 8 ADV! $ GEN'L AGGREGATE LIMIT APPLiESPER: j IGENERAL AGGREGATE is 2,000,0001 r—, Fill POLICY ;j� I LOC ;PRODUCTS--GOMPtOPAGG 18 2,000,00fl? �1 OTHER. B :AUTOMOBILE LIABILITY j 'COMBINED SINGLE LIMIT 1,fl0fl,flOfli LtI a amdenti 1 S ANY AUTO _ X ; 16237702 0410812018 j 04/0812019 BODILY INJURY'Pet IS 1 OWNED i SCHEDULED AUTOS ONLY X I —; �;AUTOS , i I BODILY INJURY(Per acdoent) $ i X i Hi I X NO �y1vE0 PpOPEBTY DAMAGE A!%S ONLY F AUTOS OtdiY 1 rper acddertt) _ 5 A ?UMBRELLA LIAO X OCCUR i 1,000,0001 ' EACH OCCURRENCE I$ , 1 X ;EXCESS UAB r CLAIMS-MADE'I X X �XOBW7126517 0610712017!06107/2019 W i3Oi)O,OOOi r i 1 AGGREGATE j5 DED j RETENTION$ i S C i WORKERS COMPENSATION i Y X ,STATUTE I ERH _ AND EMPLOYERS LIABILITY Y i N ' ANY PROPRIETOR,•PARTNERIEXECUTIVE I ? �WC0849257 j 04104120181 MOV2019 j $ �600,000 0 I ER�MEn SFR�EXCLUDED? M ? E.L.EACH ACCIDENT � .N 1 A I 1 i N E.L.DISEASE-EA.EMPLOYEE 8 500,000 if yes,nesrsice uncei DESCRIPTION OF OPERATIONS oelow i I i I E.L.DISEASE-POLICY LIMIT S0,000 I f I i i ? I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Scheduie,rrmy be attached If more space is required) Actian Inc.and NGRID USA,its direct and indirect parents,subsidiaries and affiliates Is added as an Additional Insured for General Liability on a Primary& .Noncontributory basis per the terms and conditions of form CG2001(04113),for Ongoing Operations per the terms and conditions of form CG2010(04113),for i :Completed Operations per the terms and conditions of form CO2037(04113)and Waiver of Subrogation applies per the terms and conditions of form i iMEG1.0241-01(04-11). :Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02116). Excess Liability is a following farm. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NGRID USA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENTATIVE Ir y I /L"- i I ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD xi T �5 h ` _`Lt • 4 S: /J///yJ//J)]yq/,', �j�/J (�/y///�Jj/�y/Jq/)//�Jy yp , j�/J�/}. ,/'. {////� //�♦ —y -� >; �/ .•/`.,' f ',./i�/f L'/i L/t!I L�(�=34%��� � �.��//e�i/L/i/t/'4f,��+C/i!t/�SE!V IJa/ .r Yy Office of Consumer Affairs and Business Regulation 10 Parr Plaza Suite 5170 fyh Boston, Ma:sathusetts 02116 4y, Home Improvement,CGhtractor Registration Type: Corporation Registration: 175683 ALTERNATIVE WEATHERIZATION,INC. F.xplration: 05J28/2019 . 2 LARK ST •w, FALL RIVER,MA 02721 z ✓- y , Update Address and return card..Mark reason for change• v . _.. _ _.CI_Acir3r .., PPs+ae�ra1 C F 1L rnI A a ;� />�„� 1H!)/Y:.jf ff f,fj�3s'/� �Ii�f2.:,.flf3!fl.;G��. • - .. ...` __...,.,._..... Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only APE:Comorabon before the expiration date. If found return to: 4adlon Wirabon Office of Consumer Affairs and Business Regulation L75683 05/28/2019 10 Park Plaza-Suite'6170 ALTERNATIVE WEATHER}ZATION,INC, ,MA 02116 TIMOTHY CABRAL FALARIVER,MA 02721 ndersecfetary o't V o 3i 8>ui@ E 4 Town -of Barnstable W" XAW- 200 Main Street, Hyannis MA 02601 508-862-4038 A lication for Building Permit PP g Application No: TB-16-3271 Date Recieved: 11/7/2016 Job Location: 49 BEECH LEAF ISLAND ROAD,CENTERVILLE Permit For: Building-Solar Panel-Residential Contractor's Name: SOLAR CITY CORPORATION State L-ic. No: .168572 Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508)640-5397 MARLBOROUGH, MA 01752 (Home)Owner's Name: BARTLETT,JOHN W& SARAH C TRS Phone: , (508)228-1322 (Home)Owner's Address: 1 MOTHBALL WAY, NANTUCKET,MA 02554 - Work Description: Install solar panels on roof of existing house,with any upgrades, if applicable,as specified by PE in Design; To be interconnected with home electrical system. 9.765 kW 31 Panels JB-0263445. Total Value Of Work To Be Performed: $13,800.00 Ee Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require,proof of workers'compensation insurance for every contractor,subcontractor,or other worker before- he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to.31-275 C.G.S.,'officers of a corporation and partners in a.partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and-that a sole proprietor of a business is not required to have coverage unless he files his intentto accept coverage. I hereby certify that l.am the owner of.the property which is the subject of this application or the authorized agent of the property owner,and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. - All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Cheryl Gruenstern 11/7/2016 (508)646-5397 Applicant Date ° Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $13,800.00 Date Paid I Amount Paid Check#or CC# Pay Type $120.38 X} {- Total Permit Fee: $120.38 in/7/2016 _ X}CC{X3C00�- CredRCard 11 Total Permit Fee Paid: >. $120.38 ------.-----... _ ..,. _....._?_ 89�s _.____-.. ..:.__ PROJECT NAME• ��J�'t,c� I�t('�(,lS�F . . � , ADDRESS: �- Gi lI���C� (� -LS �C�h� p�. 1 , PERAHT# PERMIT DATE: j M/P: 1 g as LARGE -ROLLED PLANS ARE IN: a BOX SLOT Data entered im MAPS program on . BY: G 6 4 q/wpfiles/forms/archive O,VW Town of Barnstable *Permit Etphr , ° Regulatory Services Fs 6 ontks om issue date BAMSTABLE, : - ee y lltA98 $ i639. ��� Thomas F. Geiler,Director ATFb AAA't 6 Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 _ www.town.barnstabld.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid wit/rout Red X-Press Imprint Map/parcel Number. 061 Property AddresskJ -Residential Value of Work � j Minimum fee of S35.00 for work under S6006.00 Owner's Name&Address Contractor's Name ���14-' Telephone Number�Q�' Home Improvement Contractor License#(if applicable) 2 k U Construction Supervisor's License 4(if applicable) ❑Workman's Compensation Insurance Check one: ' -PRESSPERMIT ❑ I am a sole proprietor ❑ I am the Homeowner ,,0.}. [ I have Worker's.Ccmpensation Insurance Insurance Company Name `^,X z V �.- � TOWN OF BAR (STABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) . Re-roof(stripping old shingles) All construction debris will be taken to U � WAS 1 Q- . ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ #of doors Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the a Impro ement Contractors License & Construction Supervisors License is required. SIGNATURE: 0:IWPFT1 FS1Ft1RM.4\huildino nertnit fnrmclFX➢RF¢C Inr The Commonwealth of-Massachusetts E l Department of Industrial Accidents d Office of Investigations 600 Washington Street Boston, M.4 02111 , wr www.mass.pov/dia N Workers' Compensation Insurance Affidavit:_ Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibl Name (Business/Organizataon/lndividual): 'e Address: 4- City/State/Zip:�E v, Phone 4: scis" r��': ``k(�26 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors , listed on the attached sheet. t 71• 2. ❑ I am a sole proprietor or partner- ❑ Remodeling- ship and have no employees These sub-contractors have 8. ❑ Demolition., working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL . I l.❑ Plumbing repairs or additions myself.[No workers' comp: c. 152, §](4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.].. *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. . -lam an employer that is providing workers'compensation insurance for my employees..Below is the policy and job site . + information. n� Insurance Company Name: Policy#or Self-ins. Lic.#: — Expiration Date: °3\ \� Ci - 0 ._ Job Site Address: h/State/Zi P C� Attach a copy of the workers'compensation policy declaration page (showing the policy number`and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of i STOP WORK ORDER and a fine of hp to$250.00 a day against the violator.'Be advised that a copy of this statement may be.forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here err !h p ' s a penalties of perjury that the information provi a above is true and correct Si afore. Date: J"', Phone#: — [J,cial use only; Do not write in this area,to be completed by city,or town official ty or Town: Permit/L,icense# suing Authority(circle one): Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Other Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and'who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to,operate a business onto construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy isTequired. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each . year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' .600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 ✓1ze -�oaninZauuecilt! o�✓filcaaaaclzuae(ta Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reg istrations-1132149 Type: Office of Consumer Affairs and Business Regulation '" �• Expiration 11/28/2012, Individual 10 Park Plaza-Suite 5170 ' r Boston,MA 02116 DEAN F.STANLEY tit -�� r •:� DEAN STANLEY 359 CAPT. LIJAH RD , CENTERVILLE, MA 02632" Undersecretary Not valid without signature -Rog" Massachusetts- Deportment of Public Safeh BO MA of Building Regulations ;Intl Standards Construction Supervisor License License: Cs 35037 Restricted to: 00 DEAN F STANLEY 359 CAPTAIN LIJAH RD ` CENTERVILLE, MA 02632 Expiration: 1/19/2012 ('ummissiuncr ' Tr#: 12334 10/29/2010 15:56 5083932273 NORTHWOOD INSURANCE PAGE 01 OF ID:TO + CERTIFICATE OF LIABILITY INSURANCE DA,10129D)YYY`() 1az9r1a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed- If SUBROGATION IS WANED,subject to the terms and Conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endomemen s. PRODUCER 508-771.1632 NAME T Northwood Ins.Agency,Inc. 608-393.2955 JAICN No'E AAIX: FC NO: 540 Maid Street,Suite 9 Hyannis,MA 02801 PRO UCERUS STANL-1 INOURER18t AFFORDING COVERA9E NAIL! 0�ttlrhEp Dean Stanley Building INSURER A-.Ube Mutual Insurance Co. Contractor,Inc. NSURER B: 359 CapL Ujahs Road INSURER C: V. Centerville,MA 02632 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAW THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 TYPE OF INSURANCE AMJMPOLICY NUMBER MMRHMYYYY MM EXP LIMITS L GENERAL LIAROM EACH OCCURRENCE $ DAMAGF TO At COMMERCIAL GENERAL LIABILITY P MI Ea OWJfrenoa $ L CLAIMS-MADE 7 OCCUR MED EXP(Any one person) f PERSONAL R ADV INJURY I GENERAL AGGREGATE _ GEN1-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 3 POLICY ,0• 7 LOG i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es ace4de" ANY AUTO BODILY INJURY(Par person) S ALL OWNED AUTOS BODILY INJURY[Per aCddaM) S SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (per accJtleM) NON-OWNED AUTOS $ UMBRELLA LIA OCCUR EACH OCCURRENCE $ E7IGESB LUW H CLAIMS-MADE AGGREGATE $ OEDUCT19LE $ RETENTION ! _LIM $ ER WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY A ANY PROPMETOWARTNERIEXECUTIVE Y❑ NIA A C13133743140110 08/31/10 08131/11 E.L.EACH ACCIDENT S 100,0 00 OFFICERIMEMBER EXCLUDED? F.L.D18EASE-EA EMPLOYE $ 100,00 (hundxwy In NN) R yae,deeCrlCe under E.L.DISEASE.POLIov GUAR $ 600,00 DESCRIPTION OF O"R8T1Q.Nt2 WNW . ... I T DESCRIPTION OF OPERATIONS 1 LOCATION$I VEHICLES (Atteeh ACORD 101.AddWanld Rnm#rtur Stheduie,it move space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dean Stanley Building ACCORDANCE WITH THE POLICY PROVISIONS. Contractor,Inc. 369 CapL Ujahs Road AUTHORRED REPRESENTATIVE Centerville,MA 02632 � �• � � � 01988-2009 ACORD CORPORATION- All rights reserved. ACORD 2S(2009109) The ACORD name and logo are registered marks of ACORD S r ti Town of Barnstable Regulatory Services HA.ftNSTASL.� � Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab(e.ma.us Office: 508-862-403 8 Fax: 508-790-623 Property Owner Must Complete and Sign This Section If Using A Builder I,. 1 �\ ir�'�s, as Owner of the subject property hereby authorize '. v to to act on my behalf, in all matters relative-to work authorized by this.buildin.g permit application for. (Address of Job) aty \ Signature of OwnerL Da Peat Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the revetse side: .. Town of Barnstable P oY tt�ray Regulatory Services uxxsrAsrr;, Thomas R Geiler,Director ' Building DiN isioii Tom Perry, Building Commissioner 200 Maui.Street, Hyannis, MA,02601 vsnv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOKEOPVNER LICENSE EXEKPTION Please Print DATE: JOB LOCAnON: number street vi l l age "HOMEOWNER": name home phone f# work phone# CURRENT MAILING ADDRESS: city/town statr zip code Tlhe current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners-to-engage an individual for hire who does not possess a license;provided.that the owner acts as supervisor. DEF=ON OFHOMEOWNER !. Persons) who owns a parcel of land on which he/sh'e iesides or intends to"reside, on which there is, or is intended to' be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constr-gcts more than one home in two-year period shall not be considered a homeowner. Such "homeowner" shall'submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the build-ing permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance,with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned `homeowner certifies that,he/she understands the Town of Barnstable Building Departmen ,� t ma=um inspection procedures and requirements and that he/she will comply with said procedures and requirements. r Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will bse required to comply with the State Building Code Section 127.0 Construction Control. SOh1E0 WNER'S EXEMPTTOT7 The Code states that "Any homeowner performing work for which a building permit is required shall be cxcmpt-from the provisions. of this scction.(Sectidn I09.1.1 -Licensing of construction Supenvsors);provided that if the homoowncr engages a parson(s)for hire to do such work, that such Homeowner swl act as supervisor." Many homeowners who use this exemption an unaware that they art assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it would with.a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsrMe To ensure that the homeowner is fully award of his/her rtsponsibilitirs,many communities require,as part of the permit application, that the hDMC:0Nyrrer certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fornn/ccrbfication for use in your Community. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION es Map Parcel lob _.Application OZ= l Health Division Date Issued 3 Conservation Division ', ..,..Application Fee Planning Dept. Permit Fee; Date Definitive Plan.Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Str et Village4q 4 . �V Owner �itVi � � Address A Telephone LRA 1��A 02&3Z Permit Request ��� fi ��� dT Vi- b. �n.� U (�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction TypeWUD RAM Lot Size Grandfathered: ❑Yes ❑ No If yes,-'attach supporting documentation. Dwelling Type: Single Family :A Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: X Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.f ��� o Number of Baths: Full: existing_ new D Half: existing w" new- co tD Number of Bedrooms: L1 existing new w x� Total Room Count (not including baths): existing new First Floor RoomCount Heat Type and Fuel: �Gas ❑Oil ❑ Electric ❑ Other 3.4 Central Air: )4 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:Z0- Ye` L3 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )(No If yes, site plan review# Current Use �VI�,c�'( Proposed Use ' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name&& `' l Telephone Number ""I�iU Tcco Address c? License # C. _O q5w "o •1JU� 1 I Home Improvement Contractor# 1 J`053 Worker's Compensation # VU ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PR JECT WILL BE TAKEN TO A "J" Dh10 SIGNATURE - -- DATE 3 b f: a FOR OFFICIAL USE ONLY APPLICATION# _ .DATE IS$IIEDrIA-1 � .,MAP/PARCEL NOa—.cy Ily '.I I� `F ADDRESS _ .. VILLAGE OWNER DATE OF INSPECTION: i - *OUNDATIONL Er� FRAME eJINSULATION r F FIREPLACE ELECTRICAL: ROUGH FINAL � t PLUMBING: ROUGH FINAL i GAS:— .-'` • ROUGH 60047H 'E3A- FINAL # IF I NA L B U I L D I NG I OWW�A isi0l ill � ASSOCIATION PLAN NO. t r : C _ r • 1.. The Commonwealth of Massachusetts �:. Department of Industrial Accidents, S ;7 Office of Investigations r` 600.Washington Street Boston,MA 02111 www.mass goWia Workers' Compensation Insurance.Affidavit:'Buil.ders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly, t Name (Business/Organization/Individual): Address: City/State/Zip: e'') . tvL 0C05- Phone 90 Are you an employer? Check the ppropriate box: Type of project(required): 1.4 1 am a employer with . 4. 0 I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- Fisted on the attached sheet. 7. 4 Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. FIBuilding addition [No workers' comp. insurance comp. insurance.$. required.] 5. F-1 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t 'c. 152, §l(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.]. *Any applicant that checks box III must also Fill out the section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees..If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins. Lie. #: � � �-f �f Expiration Date: Job Site Address: LM l,�C�CiI l City/State/Zip:&"Ile/IVI� OZ& Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby of de th pains and penalties of perjury that the information provided above is true and correct. Si nature: —_- q' /_ Date: J t7 Phone#: 2-D" lv Official use only. Do not write in this area, to be completed by.ciry or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk' 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M DN ,aco o® os/29/CERTIFICATE OF LIABILITY INSURANCE DATE( /2012 Y) �..� olz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT G@rmanl Insurance Agency - NAME:PHONE - FAX 908 Main Street c o 508 428-9194 Alc No: 508 428-3068 Osterville,MA 02655 E-MAILDE s: INSURERS AFFORDING COVERAGE NAIC q INSURER A:SAFETY INS CO INSURED INSURER B: Scott Peacock Building&Remodelling,Inc. INSURER c P.O.Box 171 Osterville,MA 02655 INSURERD: Commerce&Industry Ins.Co. INSURER E:. - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEJN,-&WVQPOLICY NUMBER MM/DDIYYYY MMIDD/YYYY - LIMITS A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LU16 OCCUR EACH OCCURRENCE $ �:D CESS LIAR CLAIMS-MADE AGGREGATE $ RETENTION$ $ - D WORKERS COMPENSATION WC 005-81-5464 6/22/2012 6/22/2013 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 100,000 It yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott Peacock Building&Remodeling,Inc. THE EXPIRATION DATE THEREOF, NOTICE- _WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fax#508-428-7625 Scott_Peacock@vedzon.net AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cnnstructiun Supervixor License: CS-094500. r JAMES S PEACO�IC ; PO BOX 171 � OSTEVILLE MA:,r0262 `4 f ✓..�.... �J� .';� �): Expiration Commissioner 07/22/2014 r i i \ Office of Cousumcr/Afl firs&R:u::ess R nr.�rrrX".;elf II�' OME IMPROVEMENT CONT r;°lation License or registration valid for individul use only egistration: RACTOR before the expiration date. if found return to: .' 151853 Type: Office of Consumer Affair 7 xpiration: 7/7/2014 s a ls.° >. Private Corporatic., 10 Park Plaza-Suite 5170 and Business Regulation SCOTT PEACOCK BUILDING& REMODELING INC Boston,MA 02116 JAMES PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE.MA 02655 r Llndcrsccreta:y jNot valid without signature - -`_ iMar. h. 2U13 j: j6r'M Global interconnect 15H563bibb No. h4/h V. I Town of Barnstable . Regulatory Semees As Thomas F.Geiler,Director a6 ]RuildingDivision Torarerry, Building Commissioner 200 Main Stmot, Hyannis,WA 02601 rvrrw.toWn.barnstabit.ma.us Office: 308-862AO38 pax; 508.790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder T, re, ��n K, u—►t^l,�'e ,as Owner of the subject prpperty he authorize i � � to act on my behalf, Mau matters relative to work authorized bythis biulding perm* application for. , 4 q Beth Lg_aF I Sf" 1q oaJ (.Address of jolt) ral ; 4ea ture of Owner At <. U/+-TIF_S Tint Name . I Q•s01WS:9rVP M FERMiSS10N 1 z 1 �T� wog TOWN OF SARNSTA9LE 2013 MRR -6 Pi9 4 13 36 X 3 a 36 v a TM�> TOWN OF BARNSTABLE 35799 °`t4..°• Permit No. ......:......... ` BUILDING DEPARTMENT '�"� ! TOWN OFFICE BUILDING Cash .... .��,63g. u ` HYANNIS.MASS.02601 Bond ,.....X..,.,.. CERTIFICATE OF USE AND OCCUPANCY Issued to BEECH LEAF NMMINEE TRUST Address 49 Beech Leaf Island Road Centerville, MA USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. July 7, ... . 19................. ........ ...` �./ / ` Buiing Inspector l TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS. 02601 '�'o rnr�• MEMO TO: Town Clerk FROM: Building Department DATE: 7 )g l 3 An Occupancy Permit has been issued for the building authorized by BuildingPermit #......_. . . 5 7 �.�_ ......._........................................................................................ ..._. ..._......._............ _ issued toQllr� ✓Q /li �f/I?0 ....�� j ....... .............................. . .� . ......__._.. . /• Please release the performance bond. Assessor's office(1st,Fbor): 6 / �� TNt Assessor's map and lot number Conservation f' 3^ — / 'NSTAU rcrzIN C �w Board of Health(3rd floor): ff r Sewage,Permit number ` �' 3a 7 ENVIROj 1 �� o VAAa Engineering Department(3rd floor): TO AL House.number �� Definitive Plan Approved by Planning Board sr 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF - BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO v V TYPE OF CONSTRUCTION CO 19 9--) _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Q I Location -1/y 9 i� l' c / Proposed Use Zoning District y Fire District Name of Owner Address ' Name of Builder Address Name of Architect Address -2 Number of Rooms Foundation Exterior Roofing F � / ` Floors L � Gfe- Interior Heating 4 1 �� Plumbing y �� L� c�t / ice Fireplace // � �` / e Approximate Cost 7r Area �O72/, Diagram of Lot and Building with Dimensions Fee Gl r it OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name /—% �✓! 7 JifHy Construction Supervisor's License 501 Vs— ,BEEC�l LEAF NOMINEE TRUST t No 35799 Permit For 11 Story Single Family Dwelling ' . Location 49 Beach Leaf Island Road `. Centerville -- Owner Beech Leaf Nominee Trust r Type of Construction' Frame , Plot Lot i g t , j Permit Granted April 21 , 19 93 - Date of Inspection 19 , w ,-I D e Ito 19 1 S� i � • f ` 1 � I w ..y,t«" 4. •is _. ' - � I �, • ., , r Mi FQ , . il i5 / 3G. 00 Izz,,621 F a � o v ' vtk."w►RD W4xTFR r' 6 t i t ' LOC,47 A5)A/ CENT"cfc'<pj(..L, -5 44 ov� iv SETBA CK 0.z- T,4/E ._OCA T;Ea lyir�//�✓ T'h�� ,�Locr�,oL�4/y `®-r- f �l .:...' 6.. '[✓ �f /r� Et .r pg. ' 3 �r• L;�. gel XT,E.0 E it/yE /RUC. Tfi!/S ,Lf1/C//S �(/�T.gASEO Get/,4�(/ A 451-57`.C,2Ep .�it%S7-.elJiv/��t/T SlU,2YEY� Th!� �STE,C>li/,C��a �J.4SS. 0;�,�-E'TS Sya1.�/y SflavLl� ypT- 8� . /C,�/L,17 TOWN Cif BARNSTABLE, MASSACHUSETTS B V A-187-079 DATE April 21, (g 93 PERMIT NO.NQ 35799 APPLICANT Owner ADDRESS Listed Below #005645 ,7 IN0.) (STREET) (CONTR'S LICENSE) PERMIT TO Build Dwelling ( 1-i ) STORY Single Family DwellinWASER OF ELLING UNITS (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) AT (LOCATION) 49 Beach Leafs Island Road, Centerville ZONING gD_1 DISTRICT- (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION �} (TYPE) REMARKS: Sewage #91-324 { Bond € AREA OR PERMIT VOLUME 2206 sq. ft. ESTIMATED COST $ 160,000. FEE $ 161. 50 (CUBIC/SQUARE FEET) OWNER Beech Leaf Nominee Trust ADDRESS Centerville BUILDING DE PT. c/ ` BY �i 1• I` I I; f 5S UANCI! OF TrqI9 PEAMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS ' OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QU(RED,SUCH BUILDING SHALLNOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS /f PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS oat HEATING INSPECTION APPROVALS E E7 DEP T ENT 1 /lips U 7 OTHER SITE PLAN REVIEW APPROVAL j '716193 49 WORK SHALL NOT PROCEED UNTIL THE INSPEC- p- ERMIT •N,i L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION �� d C BRADLEY. BARRY & TARLOW, P. C. ICI ANCN STREET BOSTON. MASSACNU5E7T5 02110 A.t. CC-?o-k I .apy - (..017 711 s�1R May 24 , 1989 Barnstable Sun. erior Court County Court C0111pieX Main Street Harnstable, PIA 02630 Re: Silvia & Silvia Associates, Inc.. Vs : Grcavc:r C.M. & Farrish, M.D. , et als Superior Court No. 88-541 Dear Sir or Madam: Ploasc find Pnclosed for filing in ttic_ above an Agreement for JUdgrent as executed by counsci for all oart:ies . I request that judgment be entered in accordance with the Agreement for Judgment with copies to counsel of rocord. Tf there is anything we can do to be of assistance:, please let us k:iow.. Sincerely, � fig T�--- • ��-----• Robert J'. aum RJR/oy Enclosure cc: Ruth J. Weil, Assistant Town At arncy Silvia & Silvia Associates , Inc. COMMONWEALTH OF MASSACHUSETTS BARNSTABLE , ss . SUPERIOR ,COURT C.A_ NO. 88-541 SILVIA & SILVI.A A:SSOC.IA7ES , INC. , ) Plaintiff ) ) v. ) ) GROVI:k C .M. FARRISH, M.J . , ANN .iA`lE ) F.SH3AU(;tI and ."'AMPS F. CRCC.:ER, Sit , ) individua I ! y and as they arc Members ) ai- the BOARD OF llk.ALTn aL the TOWN ) OF 11ARNSTABLE, ) Dcf n,',arits ) AGR1:KMPNT FOR JUDG:�?cN'I� The parties hereto stipulate and agree that - judgment shall enter for the Plaintiff and against the Defendants as follows : 1. The Plaintiff shall be granted a variance from the regulation of the Board of Health of the Town of Barnstable which requires that septic systems be located at least 100 fe.ct ft-om wetlands , for the construction. of one single-family residence and garage upon Lots 14 , 14A, 15 and 15A, Beach T,oaf island Road, as further described in the Complaint, and as more spccifical. i.y described below. Such a variance will not medni.nytul.ly diminish th:: decree of an cnvironmental protection Sought by the Board cif IIez It i ` `i 'local regulation an(i the requirements of Title of ::he State Environmental Code , 310 C .M.R. 15 . 00 et Suu. + 2 . No disposal wcjrks installation permit shall issue until ni.w plan:: , in conformance with the conditions of this variance , have bean approved by the Barnstable Boar%1 of Health. 3 . Roth the primary and reserve area,, for the septic system for the above--mentioned dwelling shall be located s�_,ve ni.y-sevr.n U/7) feet. or more from the wctlanri limit as. shown on tr.e pro jc ct plans prc:v i ously submittet'! to the Board Of Health with Plainti`F ' s petitions for variance,, . 4 . The proposed dwelling may have: the following rooms : 4 bedrooms plus 5 other rooms , not including bathrooms , which may have any or all of the following uses : living room, hitchCTI, dining roam, family room, den, study', library, or workshop . For the purposes of sewage f low doterminaticn and whether a reserve: area must be built , the proposed dwellinrg shall constitute a six-:bedroom home. There shall no restriction on the number of bath.:-.oms, , closets , storage areas , nor upon such other spacers as hallways , foyers and entries , nor shall there bF: any reslr3 ci:iuns on thc: size of thc! garage . 6 . There shall be no future expansion of the septic ;system and there Shall be no future expansion of the hahitabl% spaces of the dwel. l..i.ng constructed beyond the design of said system witl*iout the approval of the Board, of Health. 7 . The bottom of the septic facility shall be established at an elevation of 1. 1 . 1 feet mean sea level . "2- ---- ---------- -------------- - -- -- - -- -- -- H ^iiL _ I'li-i =>�J �i i 1(r,;:_,cJ r.4' E� The variance granted in accordance herewith shall run for a period 'of at 1easL three years from its date of issuance and be thereafter shall continue as permitted by law. 9 . The capacity of -;cptic system for the 'dwelling to be constructed shall ineet the present requirements of Title 5 of the. Stat4' Environmental Code and the rcguiations of t-h�:! Town of Barnstable Board of Iicalth. It. is. agreed ghat each party has cooperated in . chr- draftinq and i.;rc�r)al-inq of tlli : AC�rE'E'.ITIE''Ilt i'or Jucic3iT,c:.t . iIIencc , any construction to he mi3t:E. of this Agreement shawl 1 not be cans rued against any party. by virtue of the party' s role in draftsmanship. 11 . Plaintiff and Defendants agree that this ngreemenc is binding upon and shall inure to the benefit of the Pl.airitiff and Dcfendants hereto , their respective agents , employees , representatives , af..f..iceF rs, directors , divisions , - subsidiaries , assigns , heirs in succession in interest, and shareholders . 12 . in all other respects the Comf.A.ai.nt is dismissed with prejudice .and no costs or attorn- eVs ' fees shall be assessed on either side. GROVLR C.M. FARRI5H, M.D . , SILVIII & SILVIA ASSOCIATES , IINC_' . et al , BOARD OF HEALTH, etc. , Plaintiff , Dc_f cndants , By their attorneys , Hy ,ttici.r at ornels , Robert D . Smith , Town Counsel Robert J . ' Baum Ruth J . Weil, Assist-. i ant Town Bradley, Barry & Tariow, P . C . CounsF! I , Town of: Bat7nsta:; I.c 101 Arch Street- 375 Main Street , New Tows: Boston , MA 02110 Hall , Fyanni s , gill 0260.1. ( 617 ) 951-1-900 ( 508 ) 775-1120 Dated: May 17 , 1989. Dated : j-�,/ 7 -:3- I � � 1 + 4p _ 2-9 �4- , 5 4 _'�4:' To t9 v�.wL. - 'L4 Zt-E L4 T rj '.4 24 17-4 1 Cv ._yes.. Ne — ! CZ I 'tti 44 G co of /� I i 1 v Lk I 'l i "o ! 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